Journal of Pregnancy and Child
Health
Editorial
Lifestyle Modifications as the first line therapy in Polycystic Ovary
Syndrome
Rajiv Mahendru* and Saloni Bansal
Department of Obstetrics and Gynaecology, BPS Govt Medical College, Khanpur Kalan, Distt Sonepat, Haryana, India
*Corresponding author: Rajiv Mahendru, Professor and Head, Department of Obstetrics and Gynaecology, BPS Govt Medical College, Khanpur Kalan, Distt Sonepat,
Haryana, India, Tel: +91 9416086483; E-mail: dr.rmahendru@gmail.com
Received date:Jan 17, 2016; Accepted date: Jan 20, 2016; Published date: Jan 28, 2016
Copyright: 2016 Leonard CA, et al., This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Introduction
Motherhood is the dream of every woman. And when it comes to
infertility we lack words to mourn an absence. There are words and
phrases to express a loss but we become wordless when it comes to
capture that particular emptiness. Who can describe the feeling of a
tiny hand that had never been held. Her desert will blossom like eden.
Her barren wilderness like the garden of the lord. PCOD is a well-
known entity and a common cause for infertility. Also known as Stein-
leventhal syndrome. Although considered to be a bane of modern
living it is an ancient disease known right from the times of
Hippocrates and Soranus of Ephesus. They noted women with mearge
menstruation are robust, with a healthy complexion and a masculine
appearance; yet they are not concerned about bearing children nor do
they become pregnant. There are women whose skin is dry and hard,
and whose nature resembles the nature of a man. This describes the
wide array of manifestations of disease.
Finally it was in 2003 when ESHRE & ASRM came together in
international consensus workshop to expand the diagnostic guidelines
for the PCOS to the so called Rotterdam criterion. The diagnosis is
based on presentation of any 2 of the 3 criterion- clinical or lab
suspicion of hyperandrogenism and ultrasound diagnosis of Polycystic
ovaries. Polycystic ovaries on ultrasound are described as ones whose
volume is more than 10 ml or the ones with follicles 12 or more in
number each measuring 2-9mm in diameter. 25% have PCO but only
5% have PCOS.
Pathophysiology
To describe the pathophysiology it is interplay of obesity, excessive
androgens and hyperinsulinemia with an established role of
intrauterine environment and genetic factors leading to disturbance of
Hypothalamic-Pituitary-Ovarian axis. Insulin Resistance &
compensatory hyperinsulinemia are the key aetiological factors. This
Insulin Resistance has a wide array of manifestations. Both obese and
non-obese have a component of Insulin Resistance, but obesity makes
your Insulin Resistance worse which together with leutinizing
hormone acts upon the ovaries to increase the androgen secretion
together with decreased production of Sex Hormone Binding Globulin
from liver, thus excessive androgens in the body.
Effects
Affects 4-8% of general population & may be associated with 75% of
women with oligomenorrhoea to as high as 90% of those with
hirsuitism. Its a lifelong condition, starts from beginning and
continues till latter years. It bothers you not just for reproductive
problems like infertility, miscarriage and pronounced adrenarche but is
J Preg Child Health
ISSN:2376-127X JPCH, an open access journal
Mahendru R, J Preg Child Health 2016, 3:1
http://dx.doi.org/10.4172/2376-127X.1000e128
Open Access
also a source of concern in the antenatal period causing hypertension,
diabetes mellitus and ?Intrauterine growth restriction. Just this is not
enough and it will haunt you with its metabolic sequelae such as DM,
HTN, hypercholesterolemia, CAD and genital tumours due to
unopposed oestrogen [1,2].
Life Style Modifications
Let us put in a step forward to make small changes that would make
big differences in our life. Lets begin with Life Style Modifications.
Diet constituting 55% carbohydrates, 15% protein and 30% fat with
less than 10% coming from saturated fats is an ideal diet as suggested
by nutritionists. Diet with low fat and high carbohydrate content will
make your insulin rise. And this raised insulin will alter the
sterioidogenic metabolism and thus the raised androgens. Secondly, it
disrupts the lipoprotein metabolism leading to hypercholesterolemia &
altered lipid metabolism resulting in abdominal obesity which in turn
will cause Insulin Resistance thus forming a viscous cycle.
Dietary Modifications
Hence, the need of the hour is the dietary modification. Actively
involve the dietician to curb on your carbohydrates and increase the
fibre content (25-30 gram a day). Fibres get digested slowly and hence
a slow rise of blood sugars. Include lots of whole foods in the diet and
cut down on junks, processed foods, soda, fruit juices, candy, cookies,
and ice-creams. Limit sugars and enriched carbohydrates. Low salt
intake; rather use lemon juice, mustard, vinegar, pepper, herbs, and
spices instead of salt to season foods. Choose unsaturated fats like low
fat dairy products, white meat and fish [3]. Use olive, corn and canola
oil for cooking. Include almonds, walnuts, and flaxseeds in your
routine [4]. Include cholesterol to less than 300 mg/d. Follow healthy
cooking practices like baking, boiling, broiling, grilling instead of
frying.
How many calories need to be cut down for attaining adequate
weight loss is still not known but an attempted target is 500 kcal/d to
achieve a goal of 3500 kcal/wk. A loss of even 5-10% will affect Insulin
Resistance and improve the reproductive outcomes. Scientists like
Hollman, Huber and Hoger have reported variable improvements in
ovulation rates, maximum achieved was 80%.
Exercise
One side of the balance has been looked upon; the other side still
remains i.e., to increase your calorie burn out. The answer is exercise.
Be physically more and more active. Involve yourself in 30 mints of
exercise daily or at least 5 days a week so that its 150 mints workout
every week [5]. This will help you lose weight or at least maintain
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Citation: Mahendru R and Bansal S (2016) Lifestyle Modifications as the first line therapy in Polycystic Ovary Syndrome . J Preg Child Health 3:
e128.doi:10.4172/2376-127X.1000e128
weight. Small changes in our daily routine like using stairs instead of
elevators, getting off 2 stops earlier than our destination or parking the
car at the end of the lot and walking that distance would also help us
with no extra efforts. Exercise can be in any form- Zumba, Pilates,
Yoga, Aerobics, Cycling, Walking or Swimming.
What do we expect: One, this will improve insulin sensitivity thus
lowering the Insulin Resistance. Two, it increases the frequency of
ovulation, hence the pregnancy rates. Decrease the cholesterol and its
metabolic consequences and a healthy body composition, third.
Although now proved beyond doubt that lifestyle interventions form
the first line therapy for the treatment of PCOS, but to quote this is a
meta-analysis of 608 participants from human reproduction which
compared lifestyle modifications versus metformin plus lifestyle
modifications [6]. It observed similar improvement in menstrual
cyclicity and spontaneous pregnancy rates. Lipid, glucose and insulin
levels remain unaltered with either. Androgen levels decreased with
metformin group only, also weight loss was greater in this group.
Lifestyle modifications without rapid weight loss lead to reduction of
central fat and insulin sensitivity which restores ovulation in
overweight infertile women with PCOS [7]. The fasting insulin, insulin
sensitivity index and luteinizing hormone improved in responders with
a significant p-value.
Also the Cochrane database 2011 compared 6 studies in terms of
primary and secondary outcomes [8]. Meta-analysis for primary
outcomes (fertility and menstrual regularity) was not done due to lack
of appropriate data, but secondary outcomes like reduced total
testosterone, fasting glucose was noted. Improvement in
anthropometric markers (weight and adiposity distribution) was also
seen. Weight loss of 5-10% was considered clinically significant and
this managed to show improvement in risk factors for coronary
vascular diseases and diabetes mellitus.
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ISSN:2376-127X JPCH, an open access journal
Page 2 of 2
Conclusion
Try to follow a healthy eating pattern. Be more active. Avoid
smoking and control your weight.
References
1. Hoeger KM (2006) Role of lifestyle modification in the management of
polycystic ovary syndrome. Best Pract Res Clin Endocrinol Metab 20:
293-310.
2. Norman RJ, Davies MJ, Lord J, Moran LJ (2002) The role of lifestyle
modification in polycystic ovary syndrome. Trends Endocrinol Metab 13:
251-257.
3. Hoeger KM (2007) Obesity and lifestyle management in polycystic ovary
syndrome. Clin Obstet Gynecol 50: 277-294.
4. Moran LJ, Brinkworth G, Noakes M, Norman RJ (2006) Effects of lifestyle
modification in polycystic ovarian syndrome. Reprod Biomed Online 12:
569-578.
5. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, et
al. (2002) Reduction in the incidence of type 2 diabetes with lifestyle
intervention or metformin. N Engl J Med 346: 393-403.
6. Tang T, Glanville J, Hayden CJ, White D, Barth JH, et al. (2006)
Combined lifestyle modification and metformin in obese patients with
polycystic ovary syndrome. A randomized, placebo-controlled, double-
blind multicentre study. Hum Reprod 21: 80-89.
7. Huber-Buchholz MM, Carey DGP, Norman RJ (1999) Restoration of
Reproductive potential by lifestyle modification in obese polycystic ovary
syndrome.Role of insulin sensitivity and leutinizing hormone. The
journal Clinical Endocrinology and metabolism 84: 1470-1474.
8. Moran LJ (2011) Lifestyle changes in women with polycystic ovary
syndrome, The Cochrane Database.
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